Abstract C133: Equitable lung cancer screening outcomes and follow-up attendance across racial and socioeconomic groups in Missouri and Illinois

Abstract Lung cancer remains the leading cause of cancer-related mortality in the United States. Yet disparities in lung cancer screening (LCS) outcomes exist and remain understudied, particularly in the Midwestern region. Our objective is to investigate disparities in lung radiology outcomes and follow-up care based on patient and provider characteristics. This cross-sectional study utilized data from the Siteman Cancer Center (SCC)’s LCS program in St. Louis, Missouri. SCC serves a majority White population (80%). The study included 1,946 individuals aged 50–80 who underwent LCS in 2023, meeting the eligibility criteria for LCS based on smoking history and age. Lung-RADS classifications were assessed as primary outcomes, with follow-up attendance analyzed among patients with high-risk findings (Lung-RADS 3 & 4, i.e. "probably benign/suspicious") from January to June 2023, requiring return by December 2023. The mean SDI rank at the zip code level was calculated and categorized into high deprivation (above 70), moderate deprivation (40-69), and low deprivation (1-39). Multinomial logistic regression was conducted. We adjusted for age, sex, insurance status, smoking status, screening indication, and provider type, and stratified results by race and sex. Our cohort was 57% Black, 41% White, 1% Asian, and 1% of another race. 54% were male and 46% female. Nearly half of the patients (48.8%) lived in areas with high SDI, 25.0% with medium SDI, and 26.3% with low SDI. 14% had findings classified as "probably benign/suspicious" (high-risk). Blacks had lower odds compared to Whites (AOR = 0.70; 95% CI: 0.49–0.99; p = 0.042) of being classified as "probably benign/suspicious." Specialist compared to primary care provider referral was associated with increased odds of receiving “probably benign/suspicious” findings (AOR = 1.75; 95% CI: 1.13–2.72; p = 0.012). Patients undergoing a repeat annual LCS were more likely to have “probably benign/suspicious” findings than those attending their first-ever baseline LCS (AOR = 2.04; 95% CI: 1.46–2.84; p < 0.001). Follow-up attendance among high-risk patients was suboptimal, with only 17.7% returning for timely repeat screening. Individuals living in areas with a high SDI were more likely to attend multiple visits compared to those in areas with a moderate SDI (AOR = 0.393, 95% CI: 0.155–1.001, p = 0.050), which approached statistical significance. We found no significant differences by insurance type or sex on any LCS outcomes. SCC successfully captured both Black and underserved populations in LCS in a predominantly White catchment area. We helped provide more equitable care, resulting in improved Lung-RADS outcomes for Black patients and likely higher follow-up attendance for patients with high SDI. These findings reveal that comprehensive screening programs can achieve population reach and equitable care delivery. However, the overall low follow-up rates among high-risk patients highlight the continued need for enhanced retention strategies and validation of these equity gains in other healthcare settings. Citation Format: Akila Anandarajah, Vaishnavi Mamillapalle, Benjamin Bowe, Beryne Odeny. Equitable lung cancer screening outcomes and follow-up attendance across racial and socioeconomic groups in Missouri and Illinois [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C133.